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Acute interstitial nephritis induced by Dioscorea quinqueloba.

Kim HY, Kim SS, Bae SH, Bae EH, Ma SK, Kim SW - BMC Nephrol (2014)

Bottom Line: Urinalysis revealed a fractional excretion of sodium of 3.77%, protein 1+, and blood 3+.Histological examination of the renal biopsy specimen showed a diffusely edematous interstitium with infiltrates composed of eosinophils, lymphocytes, and neutrophils.Here, we present the first reported case of biopsy-proven acute interstitial nephritis following ingestion of D. quinqueloba associated with skin rash, eosinophilia, and increased plasma immunoglobulin E level.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 501-757, Korea. skimw@chonnam.ac.kr.

ABSTRACT

Background: The use of herbal medicine may be a risk factor for the development of kidney injury, as it has been reported to cause various renal syndromes. Dioscorea quinqueloba is a medicinal herb that is used as an alternative therapy for cardiovascular disease and various medical conditions.

Case presentation: A 52-year-old man was admitted with complaints of skin rash and burning sensation. He had ingested a raw extract of D. quinqueloba as a traditional remedy. Laboratory tests revealed the following values: absolute eosinophil count, 900/mm(3); serum creatinine level, 2.7 mg/dL; and blood urea nitrogen, 33.0 mg/dL. The immunoglobulin E level was markedly increased at 1320.0 IU/mL. Urinalysis revealed a fractional excretion of sodium of 3.77%, protein 1+, and blood 3+. Histological examination of the renal biopsy specimen showed a diffusely edematous interstitium with infiltrates composed of eosinophils, lymphocytes, and neutrophils.

Conclusion: Here, we present the first reported case of biopsy-proven acute interstitial nephritis following ingestion of D. quinqueloba associated with skin rash, eosinophilia, and increased plasma immunoglobulin E level.

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Related in: MedlinePlus

The pathologic findings of the biopsy specimen were compatible with those of acute interstitial nephritis. A Interstitial inflammation composed of eosinophils, lymphocytes, and neutrophils (×200, H&E stain). B Numerous eosinophils (arrow) in the interstitium and mild tubular cell flattening (×400, H&E stain).
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Figure 3: The pathologic findings of the biopsy specimen were compatible with those of acute interstitial nephritis. A Interstitial inflammation composed of eosinophils, lymphocytes, and neutrophils (×200, H&E stain). B Numerous eosinophils (arrow) in the interstitium and mild tubular cell flattening (×400, H&E stain).

Mentions: A 52-year-old man was admitted with complaints of skin rash and burning sensation. He had noticed erythematous, variable-sized macules and patches on the dorsum of his feet and ankles (Figure 1), as well as swelling and redness on both metacarpophalangeal joints. He had ingested a raw extract of D. quinqueloba as a traditional remedy (Figure 2). The following day, he experienced symptoms of nausea, vomiting, and diarrhea. He had a history of hyperthyroidism and was treated with 5 mg of methimazole once daily. He denied the use of any other medication or supplements except for D. quinqueloba. On admission, the patient was afebrile, with normal blood pressure and pulse rate. Laboratory studies revealed the following values: white blood cell count, 9,900/mm3; absolute eosinophil count, 900/mm3; hemoglobin, 15.3 g/dL; platelet count, 193,000/mm3; aspartate aminotransferase, 27 U/L; alanine aminotransferase, 11 U/L; and total bilirubin, 0.65 mg/dL. Serological tests showed that the levels of anti-neutrophil cytoplasmic antibody, antinuclear antibody, complements, and double-stranded DNA were within the normal range. The urine output was 4.0 L/day. The serum creatinine level was 2.7 mg/dL, and blood urea nitrogen was 33.0 mg/dL. The level of immunoglobulin (Ig) E was markedly increased at 1320.0 IU/mL (institution laboratory reference of <100 IU/mL). Urinalysis showed a sodium concentration of 50 meq/L, fractional excretion of sodium of 3.77%, protein 1+, and blood 3+. The 24-hour urinary protein excretion was 930 mg/day. The kidney ultrasonography revealed slightly large and hyper-echogenic but morphologically normal kidneys, no scarring, good cortical preservation, and no evidence of hydronephrosis. On day 3, biopsies of the skin (Figure 1) and kidney (Figure 3) were performed. The kidney specimen contained 26 glomeruli, with no evidence of global or segmental sclerotic lesions. The glomerular basement membranes appeared normal, and there was no glomerular proliferation, inflammation, or other abnormality. Most of the changes involved the renal tubules and interstitium. Moreover, the interstitium was diffusely expanded by edema, with infiltrates composed of eosinophils, lymphocytes, and neutrophils. A limited number of red blood cell (RBC) casts were observed in the renal tubules and RBC extravasation was observed in the interstitium. Immunofluorescence staining was negative for IgA, IgM IgG, C3, C4, as well as kappa and lambda chains. Electron microscopy revealed no evidence of foot process effacement or electron-dense deposits. The pathologic findings of the kidney biopsy were compatible with those of AIN. The renal function progressively improved, and the patient was discharged with a serum creatinine of 1.1 mg/dL.


Acute interstitial nephritis induced by Dioscorea quinqueloba.

Kim HY, Kim SS, Bae SH, Bae EH, Ma SK, Kim SW - BMC Nephrol (2014)

The pathologic findings of the biopsy specimen were compatible with those of acute interstitial nephritis. A Interstitial inflammation composed of eosinophils, lymphocytes, and neutrophils (×200, H&E stain). B Numerous eosinophils (arrow) in the interstitium and mild tubular cell flattening (×400, H&E stain).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4236634&req=5

Figure 3: The pathologic findings of the biopsy specimen were compatible with those of acute interstitial nephritis. A Interstitial inflammation composed of eosinophils, lymphocytes, and neutrophils (×200, H&E stain). B Numerous eosinophils (arrow) in the interstitium and mild tubular cell flattening (×400, H&E stain).
Mentions: A 52-year-old man was admitted with complaints of skin rash and burning sensation. He had noticed erythematous, variable-sized macules and patches on the dorsum of his feet and ankles (Figure 1), as well as swelling and redness on both metacarpophalangeal joints. He had ingested a raw extract of D. quinqueloba as a traditional remedy (Figure 2). The following day, he experienced symptoms of nausea, vomiting, and diarrhea. He had a history of hyperthyroidism and was treated with 5 mg of methimazole once daily. He denied the use of any other medication or supplements except for D. quinqueloba. On admission, the patient was afebrile, with normal blood pressure and pulse rate. Laboratory studies revealed the following values: white blood cell count, 9,900/mm3; absolute eosinophil count, 900/mm3; hemoglobin, 15.3 g/dL; platelet count, 193,000/mm3; aspartate aminotransferase, 27 U/L; alanine aminotransferase, 11 U/L; and total bilirubin, 0.65 mg/dL. Serological tests showed that the levels of anti-neutrophil cytoplasmic antibody, antinuclear antibody, complements, and double-stranded DNA were within the normal range. The urine output was 4.0 L/day. The serum creatinine level was 2.7 mg/dL, and blood urea nitrogen was 33.0 mg/dL. The level of immunoglobulin (Ig) E was markedly increased at 1320.0 IU/mL (institution laboratory reference of <100 IU/mL). Urinalysis showed a sodium concentration of 50 meq/L, fractional excretion of sodium of 3.77%, protein 1+, and blood 3+. The 24-hour urinary protein excretion was 930 mg/day. The kidney ultrasonography revealed slightly large and hyper-echogenic but morphologically normal kidneys, no scarring, good cortical preservation, and no evidence of hydronephrosis. On day 3, biopsies of the skin (Figure 1) and kidney (Figure 3) were performed. The kidney specimen contained 26 glomeruli, with no evidence of global or segmental sclerotic lesions. The glomerular basement membranes appeared normal, and there was no glomerular proliferation, inflammation, or other abnormality. Most of the changes involved the renal tubules and interstitium. Moreover, the interstitium was diffusely expanded by edema, with infiltrates composed of eosinophils, lymphocytes, and neutrophils. A limited number of red blood cell (RBC) casts were observed in the renal tubules and RBC extravasation was observed in the interstitium. Immunofluorescence staining was negative for IgA, IgM IgG, C3, C4, as well as kappa and lambda chains. Electron microscopy revealed no evidence of foot process effacement or electron-dense deposits. The pathologic findings of the kidney biopsy were compatible with those of AIN. The renal function progressively improved, and the patient was discharged with a serum creatinine of 1.1 mg/dL.

Bottom Line: Urinalysis revealed a fractional excretion of sodium of 3.77%, protein 1+, and blood 3+.Histological examination of the renal biopsy specimen showed a diffusely edematous interstitium with infiltrates composed of eosinophils, lymphocytes, and neutrophils.Here, we present the first reported case of biopsy-proven acute interstitial nephritis following ingestion of D. quinqueloba associated with skin rash, eosinophilia, and increased plasma immunoglobulin E level.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 501-757, Korea. skimw@chonnam.ac.kr.

ABSTRACT

Background: The use of herbal medicine may be a risk factor for the development of kidney injury, as it has been reported to cause various renal syndromes. Dioscorea quinqueloba is a medicinal herb that is used as an alternative therapy for cardiovascular disease and various medical conditions.

Case presentation: A 52-year-old man was admitted with complaints of skin rash and burning sensation. He had ingested a raw extract of D. quinqueloba as a traditional remedy. Laboratory tests revealed the following values: absolute eosinophil count, 900/mm(3); serum creatinine level, 2.7 mg/dL; and blood urea nitrogen, 33.0 mg/dL. The immunoglobulin E level was markedly increased at 1320.0 IU/mL. Urinalysis revealed a fractional excretion of sodium of 3.77%, protein 1+, and blood 3+. Histological examination of the renal biopsy specimen showed a diffusely edematous interstitium with infiltrates composed of eosinophils, lymphocytes, and neutrophils.

Conclusion: Here, we present the first reported case of biopsy-proven acute interstitial nephritis following ingestion of D. quinqueloba associated with skin rash, eosinophilia, and increased plasma immunoglobulin E level.

Show MeSH
Related in: MedlinePlus